Claims Manager

Chicago Public Schools•Chicago, IL

5d•Onsite

About The Position

The Talent Office supports and empowers employees through all stages of their Chicago Public Schools (CPS) careers, with the understanding that the department’s success enables employees to better serve the students of Chicago. Reporting to the Executive Director of Healthcare & Benefits, the Claims Manager is responsible for overseeing the administration of the Workers’ Compensation and Unemployment Insurance programs as well as OSHA reporting compliance. This role establishes and maintains standards and procedures for claims “Best Practices” both internally and externally for all aspects of the programs. The Claims Manager provides leadership and guidance to a team of direct reports, develops and implements strategies to reduce and/or eliminate the financial exposure through accident and injury reduction, ensure timely response and compliance with Local, State, and Federal agencies regarding safety and environmental issues, and ensure liability coverage for the district.

Requirements

Bachelor's degree from an accredited college or university is required
Minimum of five (5) years of Workers’ Compensation claims management and basic knowledge of Unemployment Insurance and HR Operations
Minimum of two (2) years of supervisory experience managing a team of direct reports
Solid experience managing relationships with TPAs, vendors, internal and external law firms
Strong knowledge of Illinois Workers Compensation Commission (IWCC), the Illinois Workers’ Compensation Commission (IWCC) process, and Occupational Health and Safety Act (OSHA)
Basic knowledge of state unemployment laws & regulations with the ability to learn quickly
Excellent written and verbal communication skills, including presentations & facilitation of trainings to a wide variety of individuals
Detail-oriented with strong communication, problem solving, critical thinking, and interpersonal skills required
Ability to articulate a vision, set high standards, and effectively team members in the realization of expectations set
Demonstrate high levels of subject matter expertise, integrity, honesty, credibility, and the courage to make difficult yet necessary decisions
Effective strategic planning capabilities, including the ability to establish long-term vision and goals, and align/manage activities toward goal fulfillment
Strong leadership and team building skills, e.g. ability to develop high performing teams united around a clear vision for serving schools and achieving student success
Knowledge of operations, budget/finance, management and organizational development
Ability to build collaborative relationships with a variety of constituent groups, including external partners, to ensure the entire system operates in the most effective manner
Ability to define problems, analyze data, and outline valid conclusions and action steps
Employees are required to live within the geographic boundaries of the City of Chicago within six months of their CPS hire date and maintain residency throughout their employment with the district. The Chicago residency requirement does not apply to temporary/part-time positions; however, all CPS employees must be residents of Illinois.

Nice To Haves

Senior Claims Law Associate (SCLA), Associate in Risk Management (ARM), Chartered Property Casualty Underwriter (CPCU) or other claims/insurance designations, preferred
Experience in public sector and unionized environments preferred
Knowledge of the PeopleSoft and Oracle system preferred.

Responsibilities

Oversee claims administration and vendor performance
Provide oversight for the Third Party Administrators (TPAs) that manage the administration of the workers’ compensation and unemployment programs for all Chicago Public Schools employees
Manage external vendors involved in the areas of claims administration, managed care, and litigation through benchmarking, loss analysis, and key performance indicators to ensure adherence to best practices as well as company specific claim program goals, directives, initiatives, policies, and procedures
Conduct and oversee all claim reviews and audits to ensure effective claims handling by external adjusters
Lead efforts in the CPOR and RFP process along with Procurement for the retention and renewal of selected vendors; Ensure that vendor contracts meet necessary terms and conditions
Stay up to date on claims assigned and team metric performance goals, providing guidance and course correction as necessary
Authorize reserves and settlements within established authority
Review and approve claim-related invoices, reconciliations, and payment requests within delegated authority
Manage collection of required regulatory and company-specific claim related data to ensure compliance with all record keeping, reporting, loss forecasting, and loss analysis requirements for actuaries
Manage Self-Insured claims programs to ensure administrative duties as well as all reporting and premium funding requirements are met
Mitigate organizational risk through safety compliance and proactive loss prevention support
Collaborate with internal and external business partners on policies and procedures for loss prevention and risk control
Provide assistance and guidance to departments regarding liability, risk issues, and safety compliance
Ensure compliance with federal and state safety regulations; coordinate and facilitate trainings including OSHA programs covering hazard assessment/personal protective equipment, Bloodborne Pathogens, and Workers Compensation
Work closely with Facilities to conduct inspections of CPS locations in order to detect any safety and/or health hazards
Participate in meetings and follow-up regarding actions and/or recommendations to the Executive Director for changes and safety practices, procedures, and/or Human Resource policy regarding employee safety
Manage all OSHA compliance and reporting responsibilities to include distribution of OSHA 300 and 300A summaries to all schools and timely reporting to the Office of Labor Relations
Maintain up to date knowledge of and manage departmental compliance with Medicare Medicaid SCHIP Expansion Act 2007 (MMSEA), Section 111
Manage handling of lawsuits involving worker’s compensation program and act as liaison with internal and external attorneys
Coordinate employee benefit and leave of absence protocols
Research and resolve employee inquiries about discrepancies with Workers’ Compensation benefits
Collaborate with Payroll, the ADA Office, and other departments as needed on issues affecting compliance with all benefit plans, including projects related to collective bargaining agreements
Provide excellent customer service to employees going out on leave of absence or requesting information about insurance, employment, and benefit entitlement
Partner with the Leaves team for employees who are off work as a result of a work related injury to include the CPS assault leave
Partner with the ADA team when appropriate to ensure correct protocol is followed as it relates to employee accommodations
Supervise, develop, and manage the performance of a team of direct reports; provide leadership, guidance, and complete their performance reviews and goal setting
Establish an annual workers’ compensation and unemployment budget, ensuring appropriate Purchase Orders are aligned; Ensure timely payment of all vendor invoices and service fees
Manage the full lifecycle of unemployment claims and administrative appeals
Act as liaison between the unemployment claims handling vendor, CPS employees, Equal Opportunity Compliance Office (EOCO), Administration and school communities to gather supportive details needed to make sufficient determinations on separation claims
Provide oversight of unemployment claims to ensure attendance at telephonic administrative hearings, preparing responses to grievances and maintaining required filings to the state of Illinois
Work with UI vendor on audits and claims to file responses and protest after a complete and thorough investigation of all applicable facts
Review all determination to approve the filing of 1st and 2nd level appeals
Provide prep sessions and post-hearing consultations for hearings
Perform other duties as assigned